early pregnancy failure
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Author(s):  
Robina Mirza ◽  
Ankita Sharma ◽  
Pooja Sharma

Background: Early pregnancy failure (EPF) is a common experience for women. Medical management allows for expulsion of the nonviable pregnancy in a controlled manner without any surgical risk. The aim of this study was to compare efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in management of EPF.Methods: This was a prospective comparative interventional randomised clinical study conducted at Shri Maharaja Gulab Singh hospital, Jammu, Jammu and Kashmir India from November 2019 to October 2020. A total of 200 patients with gestational age less than 13 weeks and ultrasound diagnosis of EPF were included in the study and randomly divided into two groups, group A (100 patients) received tab. mifepristone 200 mg orally 24 hrs before the use of Tab misoprostol 800 ug per vaginally. If no expulsion occurs within 4 hours, repeat doses of 400 ug misoprostol were given per vaginally at 4-hourly interval to a maximum of 2 doses in women less than or equal to 9 weeks by ultrasound and 4 doses in women more than 9 weeks by ultrasound. Group B (100 patients) received only Tab misoprostol in similar doses without prior mifepristone. The study was performed after approval from the institutional ethical committee. The data was analysed using computer software Microsoft Excel, Statistical and IBM SPSS version 21.0. The statistical difference in mean value between two groups was tested using unpaired ‘t’ test. The qualitative data was compared using Fischer’s exact test.Results: The success rate was higher in group A 92% than group B where it was 76%. The mean induction-abortion interval and dose of misoprostol required for expulsion were 6.56±.66 hrs in group A and 10.40±4.33 hrs in group B and 1126.88±536.06 ug in group A and 1583.33±364.58 ug in group B. The patients in group A experienced significantly less side effects than those in group B, 19% versus 32% and also required fewer blood transfusions than group B, 2% versus 5%.Conclusions: In the present study we came to the conclusion that mifepristone followed by misoprostol is more effective, safe and acceptable than misoprostol alone.


Author(s):  
Reema Khajuria ◽  
Arushi Suri ◽  
Rohini Jaggi

Background: Misoprostol use in early pregnancy failure is varied and dose is not well established. Aim of this study was to compare efficacy and side effects of 600 versus 800 micrograms vaginal misoprostol in early pregnancy failure.Methods: A randomized prospective observational study was conducted in the postgraduate department of obstetrics and gynaecology, SMGS hospital Jammu from November 2018 to October 2019 after getting approval from the ethical committee. Hundred patients (50 in group A and 50 in group B) admitted in labour room before 12 weeks of gestation with an ultrasound diagnosis of early fetal demise (missed abortion or brightened ovum) were treated medically with different doses of vaginal misoprostol.Results: The success rate in patients in group A is 72% and group B is 88%, p=0.045 (difference is statistically significant). Patients who required suction and evacuation were 28% in group A and 12% in group B.Conclusions: Use of misoprostol for medical management of 1st trimester missed/anembryonic is an effective, cheap, safe and convenient alternative to surgical evacuation. It was concluded that 800 micrograms vaginal misoprostol is more effective than 600 micrograms vaginal misoprostol. But 800 micrograms misoprostol has more side effects than 600 micrograms vaginal misoprostol.


Author(s):  
Nick Wheelhouse ◽  
Sadie Kemp ◽  
Jo E. B. Halliday ◽  
Efstathios Alexandros Tingas ◽  
W. Colin Duncan ◽  
...  

NA


2021 ◽  
pp. 129-131
Author(s):  
Jahnvi Varshney ◽  
Shivani Agarwal ◽  
Sangita N Ajmani

Purpose of the study- To study the efcacy of mifepristone followed by misoprostol over misoprostol alone in early pregnancy failure in terms of complete evacuation of uterus. METHODS: In a randomized comparative study at the Department of Obstetrics and Gynaecology of Kasturba Hospital, 100 women with early pregnancy failure and gestational age ≤12 weeks between January 2017 and December 2017 were recruited. Of these, 50 women were given a single oral dose of mifepristone (200 mg) followed by 800 mcg misoprostol vaginally (if required) after 24 hours and the other 50 women were treated with 800 mcg misoprostol vaginally alone. RESULTS: Complete evacuation of uterus was achieved in 96% women treated with a sequential combination of mifepristone and misoprostol versus 84% women treated with misoprostol alone. The difference in the rate of complete expulsion was 12% (p <0.05, 95% CI). Also, pre-treatment with mifepristone resulted in statistically signicant reduction in induction to abortion interval (2.40 ± 1.774 vs 3.30 ± 1.951 hr), amount of bleeding (402.2 ± 111.84 vs 535.0 ± 114.84 ml) and duration of bleeding (10.7 ± 2.30 vs 12.4 ± 3.38 days). CONCLUSION Medical treatment of early pregnancy failure with a sequential combination of mifepristone and misoprostol was more effective than misoprostol alone. Hence, women with early pregnancy failure may be offered mifepristone pretreatment before misoprostol to increase the chance of successful management, while reducing the need for surgery.


2021 ◽  
Vol 16 (2) ◽  
pp. 63-67
Author(s):  
Nasima Begum ◽  
Shahnaz Akhter ◽  
Luna Laila

Introduction: Misoprostol is increasingly used to treat women who have a failed pregnancy may be due to blighted ovum (anembryonic gestation), incomplete abortion, missed abortion, inevitable abortion in the first trimester. Medical treatment with Misoprostol is an alternative to conventional surgical treatment. Use of Misoprostol is simple, highly acceptable, noninvasive and preferred by women. In addition to surgical risk and patient's preference, medical evacuation reduces the need for hospital stay and the overall management cost. Objective: To determine the efficacy and safety of Misoprostol for evacuation of uterus in early pregnancy loss and to compare the result with surgical evacuation. Materials and Methods: It was a prospective randomized study conducted on 50 patients at the department of Obstetrics and Gynaecology, Border Guard Hospital, Dhaka during the period from February 2018 to July 2019. Here 25 patients received Misoprostol as medical treatment and 25 patients received surgical treatment. Results: Of the 25 women assigned to receive Misoprostol, 19(76%) had complete expulsion by 24 hours and 22(88%) by 7 days. Complete evacuation after 1st dose was 68% and after 2nd dose 88%. Misoprostol treatment failed in 3(12%) cases and required surgical evacuation. Among the respondents 80% women stated that they would use Misoprostol again if the need arises. Conclusion: Medical treatment with Misoprostol is a cheaper alternative to surgery. Given its success rate near about 88% with mild side effects controllable with additional medication and above all patient’s satisfaction, it should be prioritized over the evacuation curettage in patients who meet the treatment criteria. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 63-67


Author(s):  
T. Saravanan ◽  
Hephzibah Kirubamani

Introduction: In the early stages of pregnancy, ultrasound is an extremely specific method for examination. This article reviews how the normal development of a baby in the first trimester of pregnancy relates to ultrasound findings. Aim: To highlight the importance of routine ultrasonography in the first trimester of pregnancy in detecting and dating gestation, its viability and early detection of anomalies and complications Methods: This descriptive study involved 100 pregnant women within 12 weeks of gestation attending antenatal clinic at Saveetha Medical college, during the study period Inclusion Criteria: Pregnant women with history of amenorrhea <12 weeks of gestation. Exclusion criteria: Individuals with history of pain abdomen and bleeding per vaginum Results: A total of 99 pregnancies were intrauterine of which 1 was anembryonic and 2 had early pregnancy failure, 15 pregnancies were redated. One ectopic and one fibroid complicating pregnancy were aslo found. Conclusion: Ultrasonography is an effective method to detect and date pregnancy, identify nonviable pregnancies, fetal abnormalities and early trimester complications. Hence it is ideal to use it routinely as screening tool during the first trimester of pregnancy.


Reproduction ◽  
2021 ◽  
Vol 162 (1) ◽  
pp. 33-45
Author(s):  
Nan Meng ◽  
Xinyue Wang ◽  
Yan Shi ◽  
Yanyan Mao ◽  
Qian Yang ◽  
...  

Decidualization is essential for the successful establishment of pregnancy, and the dysregulated decidualization may lead to early pregnancy loss. It was previously reported by us that miR-3074-5p could promote apoptosis but inhibit invasion of human extravillous trophoblast (EVT) cells in vitro, and the expression level of miR-3074-5p in villus tissues of recurrent miscarriage (RM) patients was significantly increased. The aim of this study was to preliminarily explore the role of miR-3074-5p played in the decidualization of human endometrial stromal cells (ESCs). It was found that the decidual expression level of miR-3074-5p in RM patients was remarkably higher than that in the control group. The overexpression of miR-3074-5p in the immortalized human ESC line, T-HESCs, showed suppressive effects not only on the cell proliferation, as well as the intracellular expression levels of cyclin B1 (CCNB1), CCND1 and CCNE1 but also on the in vitro-induced decidualization. CLN8 mRNA, encoding an endoplasmic reticulum (ER)-associated membrane protein, was validated to be directly targeted by miR-3074-5p. And, the expression level of CLN8 was continuously increased along with the decidualization process, whereas down-regulated CLN8 expression could inhibit the decidualization of T-HESCs in vitro. Furthermore, contrary to the increased expression level of miR-3074-5p, a significantly decreased CLN8 expression was observed in decidual tissues of RM patients. Collectively, these data suggested that an increased miR-3074-5p expression in ESCs might cause early pregnancy failure by disturbing decidualization of ESCs via the miR-3074-5p/CLN8 pathway, providing a potential diagnostic and therapeutic target for RM.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
O Greer ◽  
E V Woon ◽  
N M Shah ◽  
M R Johnson ◽  
V Male

Abstract Study question Does uterine natural killer cell functional activity differ in women with recurrent miscarriage (RM) or implantation failure (RIF) compared to fertile controls? Summary answer There is insufficient data to conclusively determine differences in uterine natural killer (NK) cell activity between women with RM/RIF and controls. What is known already Uterine NK cell (uNK) function is central to maintaining healthy pregnancy by promoting placentation and spiral artery vascular remodelling. The range of uNK activity is diverse and includes cytokine secretion, such as IFN-γ, or angiogenic factors which promote vascular remodelling. Despite an abundance of studies investigating peripheral blood NK cell cytotoxicity, there is limited evidence of uNK cytotoxicity. uNK-trophoblast interactions are facilitated by uNK receptors such as CD94, LILRB1 and KIRs. It is possible that dysfunction of these diverse uNK activities plays a more important role in early pregnancy failure than uNK levels. Study design, size, duration We conducted a systematic review of prospective case-control studies investigating uterine natural killer cell activity in patients with RM or RIF versus controls. The aim was to determine whether there was a distinct variation in uNK activity between RM/RIF and controls. We stratified uNK activity into four broad categories: i) regulation and receptors; ii) cytotoxicity; iii) expression of cytokines; iv) effect on uterine vasculature. Participants/materials, setting, methods The electronic database search included MEDLINE, EMBASE, Web of Science and bibliographies from included articles from inception to December 2020 using a combination of MESH and keywords. Search, screen, and data extraction were performed by two reviewers independently. Quality assessment was conducted with ROBINS-I. Out of 4636 studies screened, 30 studies (1696 women) were analysed for uNK activity. Main results and the role of chance Different methods were used to measure uNK activity including immunohistochemistry, flow cytometry, ELISA, PCR and Western blot. Samples were obtained from endometrium during mid-luteal phase or decidua following surgery. 14 studies reported on uNK phenotypes associated with regulation and receptors. RM/RIF patients, compared to controls, demonstrated a reduced expression of KIR2DL4, KIR2DL3/L2/S2 and inhibitory receptors (NKG2A); whereas there was a higher expression of the activating receptor (NKp46) and CD161. One study reported correlation between FoxP3+ T-cells and CD56+ NK cells but another reported no similar correlation with CD57+/CD56+ ratio. Two studies investigating dNK cytotoxicity, using chromium release or lactate dehydrogenase release assays, concluded higher dNK cytotoxicity in RM patients. Eight studies reported on cytokine expression. Interestingly, two studies found lower expression of IFN-g, but four studies reported otherwise in RM patients. Two studies found a higher ratio of dNK producing IFN-γ/TNF-α to those producing IL–4. The rest of the studies reported lower expression of IL–1RA, IL–10, TNF-α, Lnc–49A and higher expression of granzyme B, perforin and PRF–1. Finally, six studies reported on effect of uNK on vasculature. Among the findings were negative correlation between CD16+ uNK and endometrial IL–6 and VEGF, as well as higher angiogenin, VEGF and bFGF expression. Limitations, reasons for caution Functional activity investigated amongst studies varied significantly; this heterogeneity precluded meta-analysis of the data. Heterogeneity also prohibited definitive conclusions on uNK function and pregnancy outcome. Studies presented data in a combination of qualitative and quantitative analysis and variation was seen in the criteria for inclusion of RM, RIF and controls. Wider implications of the findings: uNK levels alone may be insufficient to guide management of early pregnancy failure. Clarification of underlying functional activity may guide therapeutic intervention and help develop new treatments. This review highlights the need for a greater understanding of the role of uNK activity in healthy pregnancy and early pregnancy failure. Trial registration number N/A


2021 ◽  
Vol 22 (10) ◽  
pp. 5323
Author(s):  
Diqi Yang ◽  
Ai Liu ◽  
Yanyan Zhang ◽  
Sha Nan ◽  
Ruiling Yin ◽  
...  

In domestic ruminants, endometrial receptivity is related to successful pregnancy and economic efficiency. Despite several molecules having been reported in the past regarding endometrial receptivity regulation, much regarding the mechanism of endometrial receptivity regulation remains unknown due to the complex nature of the trait. In this work, we demonstrated that the cysteine-rich transmembrane bone morphogenetic protein (BMP) regulator 1 (CRIM1) served as a novel regulator in the regulation of goat endometrial receptivity in vitro. Our results showed that hormones and IFN-τ increased the expression of CRIM1 in goat endometrial epithelial cells (EECs). Knockdown of CRIM1 via specific shRNA hindered cell proliferation, cell adhesion and prostaglandins (PGs) secretion and thus derailed normal endometrial receptivity. We further confirmed that receptivity defect phenotypes due to CRIM1 interference were restored by ATG7 overexpression in EECs while a loss of ATG7 further impaired receptivity phenotypes. Moreover, our results showed that changing the expression of ATG7 affected the reactive oxygen species (ROS) production. Moreover, mR-143-5p was shown to be a potential upstream factor of CRIM1-regulated endometrial receptivity in EECs. Overall, these results suggest that CRIM1, as the downstream target of miR-143-5p, has effects on ATG7-dependent autophagy, regulating cell proliferation, cell adhesion and PG secretion, and provides a new target for the diagnosis and treatment of early pregnancy failure and for improving the success rates of artificial reproduction.


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